Skip to main content
Top
Published in: BMC Pulmonary Medicine 1/2015

Open Access 01-12-2015 | Research article

Exercise training improves physical fitness in patients with pulmonary arterial hypertension: a systematic review and meta-analysis of controlled trials

Authors: Roselien Buys, Andrea Avila, Véronique A Cornelissen

Published in: BMC Pulmonary Medicine | Issue 1/2015

Login to get access

Abstract

Background

Pulmonary arterial hypertension (PAH) is a progressive disorder characterized by hypertension in the pulmonary arteries. PAH leads to symptoms such as shortness of breath, dizziness, leg edema and chest pain, impacting heavily on quality of life. The aim of this systematic review and meta-analysis was to determine the effect of exercise training to improve physical fitness and functionality in patients with PAH.

Methods

A search was conducted for controlled trials using the databases Medline, Embase, SPORT Discus and Cochrane Central Register of Controlled Trials. Studies were included if at least 80% of the participants presented with group 1 PAH and if the intervention consisted of an exercise training program of at least 3 weeks duration. Data were extracted on study quality, participant and exercise intervention characteristics, and outcomes. Data were pooled by the generic inverse variance method using random effect models and were expressed as weighted means and 95% confidence intervals (CI).

Results

Of 110 identified abstracts, 5 studies with 106 patients (exercise: 53; control: 53; mean age 49.7 years) were included. Disease severity ranged from mild to severe; 96 patients suffered from PAH, 10 patients had chronic thromboembolic pulmonary hypertension. Exercise training led to an increase in 6 minute walk distance (72.5 m; 95% CI 46.0 m to 99.1 m; p < 0.0001) and peak oxygen uptake (2.16 mL/kg/min; 95% CI 2.16 to 3.93; p = 0.02). No severe adverse events during exercise were reported.

Conclusions

Our findings suggest that an exercise training program positively influences exercise tolerance and functional capacity in patients with PAH.
Appendix
Available only for authorised users
Literature
1.
go back to reference Galie N, Hoeper MM, Humbert M, Torbicky A, Vachiery JL, Barbera JA, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J. 2009;30:2493–537.CrossRefPubMed Galie N, Hoeper MM, Humbert M, Torbicky A, Vachiery JL, Barbera JA, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J. 2009;30:2493–537.CrossRefPubMed
2.
go back to reference Desai SA, Channick RN. Exercise in patients with pulmonary arterial hypertension. J Cardiopulm Rehabil Prev. 2008;28:12–6.CrossRefPubMed Desai SA, Channick RN. Exercise in patients with pulmonary arterial hypertension. J Cardiopulm Rehabil Prev. 2008;28:12–6.CrossRefPubMed
3.
go back to reference Arena R, Lavie CJ, Milani RV, Myers J, Guazzi M. Cardiopulmonary exercise testing in patients with pulmonary arterial hypertension: an evidence-based review. J Heart Lung Transplant. 2010;29:159–73.CrossRefPubMed Arena R, Lavie CJ, Milani RV, Myers J, Guazzi M. Cardiopulmonary exercise testing in patients with pulmonary arterial hypertension: an evidence-based review. J Heart Lung Transplant. 2010;29:159–73.CrossRefPubMed
4.
go back to reference Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJ, Ebrahim S, et al. Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev. 2014;4:CD003331.PubMed Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJ, Ebrahim S, et al. Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev. 2014;4:CD003331.PubMed
5.
go back to reference Langer D, Hendriks E, Burtin C, Probst V, Van Der Schans C, Paterson W, et al. A clinical practice guideline for physiotherapists treating patients with chronic obstructive pulmonary disease based on a systematic review of available evidence. Clin Rehabil. 2009;23:445–62.CrossRefPubMed Langer D, Hendriks E, Burtin C, Probst V, Van Der Schans C, Paterson W, et al. A clinical practice guideline for physiotherapists treating patients with chronic obstructive pulmonary disease based on a systematic review of available evidence. Clin Rehabil. 2009;23:445–62.CrossRefPubMed
6.
go back to reference Vanhees L, Rauch B, Piepoli M, Van Buuren F, Takken T, Börjesson M, et al. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular disease (Part III). Eur J Prev Cardiol. 2012;19:1333–56.CrossRefPubMed Vanhees L, Rauch B, Piepoli M, Van Buuren F, Takken T, Börjesson M, et al. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular disease (Part III). Eur J Prev Cardiol. 2012;19:1333–56.CrossRefPubMed
7.
go back to reference Duppen N, Takken T, Hopman MT, Ten Harkel AD, Dulfer K, Utens EM, et al. Systematic review of the effects of physical exercise training programmes in children and young adults with congenital heart disease. Int J Cardiol. 2013;168:3.CrossRef Duppen N, Takken T, Hopman MT, Ten Harkel AD, Dulfer K, Utens EM, et al. Systematic review of the effects of physical exercise training programmes in children and young adults with congenital heart disease. Int J Cardiol. 2013;168:3.CrossRef
9.
go back to reference de Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother. 2009;55:129–33.CrossRefPubMed de Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother. 2009;55:129–33.CrossRefPubMed
10.
go back to reference Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83:713–21.PubMed Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83:713–21.PubMed
11.
go back to reference Follmann D, Elliott P, Suh I, Cutler J. Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol. 1992;45:769–73.CrossRefPubMed Follmann D, Elliott P, Suh I, Cutler J. Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol. 1992;45:769–73.CrossRefPubMed
12.
go back to reference Dersimonian R, Kacker R. Random-effects model for meta-analysis of clinical trials: an update. Contemp Clin Trials. 2007;28:105–14.CrossRefPubMed Dersimonian R, Kacker R. Random-effects model for meta-analysis of clinical trials: an update. Contemp Clin Trials. 2007;28:105–14.CrossRefPubMed
13.
go back to reference Schmidt FL, Oh IS, Hayes TL. Fixed- versus random-effects models in meta-analysis: model properties and an empirical comparison of differences in results. Br J Math Stat Psychol. 2009;62:97–128.CrossRefPubMed Schmidt FL, Oh IS, Hayes TL. Fixed- versus random-effects models in meta-analysis: model properties and an empirical comparison of differences in results. Br J Math Stat Psychol. 2009;62:97–128.CrossRefPubMed
14.
go back to reference Borenstein MHL, Higgins JPT, Rothstein HR. Introduction to meta-analysis. New York: John Wiley & Sons, Ltd; 2009. p. 272–92.CrossRef Borenstein MHL, Higgins JPT, Rothstein HR. Introduction to meta-analysis. New York: John Wiley & Sons, Ltd; 2009. p. 272–92.CrossRef
15.
go back to reference Chan L, Chin LM, Kennedy M, Woolstenhulme JG, Nathan SD, Weinstein AA, et al. Benefits of intensive treadmill exercise training on cardiorespiratory function and quality of life in patients with pulmonary hypertension. Chest. 2013;143:333–43.CrossRefPubMed Chan L, Chin LM, Kennedy M, Woolstenhulme JG, Nathan SD, Weinstein AA, et al. Benefits of intensive treadmill exercise training on cardiorespiratory function and quality of life in patients with pulmonary hypertension. Chest. 2013;143:333–43.CrossRefPubMed
16.
go back to reference Weinstein AA, Chin LM, Keyser RE, Kennedy M, Nathan SD, Woolstenhulme JG, et al. Effect of aerobic exercise training on fatigue and physical activity in patients with pulmonary arterial hypertension. Respir Med. 2013;107:778–84.CrossRefPubMedPubMedCentral Weinstein AA, Chin LM, Keyser RE, Kennedy M, Nathan SD, Woolstenhulme JG, et al. Effect of aerobic exercise training on fatigue and physical activity in patients with pulmonary arterial hypertension. Respir Med. 2013;107:778–84.CrossRefPubMedPubMedCentral
17.
go back to reference Martinez-Quintana E, Miranda-Calderin G, Ugarte-Lopetegui A, Rodriguez-Gonzalez F. Rehabilitation program in adult congenital heart disease patients with pulmonary hypertension. Congenit Heart Dis. 2010;5:44–50.CrossRefPubMed Martinez-Quintana E, Miranda-Calderin G, Ugarte-Lopetegui A, Rodriguez-Gonzalez F. Rehabilitation program in adult congenital heart disease patients with pulmonary hypertension. Congenit Heart Dis. 2010;5:44–50.CrossRefPubMed
18.
go back to reference Mereles D, Ehlken N, Kreuscher S, Ghofrani S, Hoeper MM, Halank M, et al. Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension. Circulation. 2006;114:1482–9.CrossRefPubMed Mereles D, Ehlken N, Kreuscher S, Ghofrani S, Hoeper MM, Halank M, et al. Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension. Circulation. 2006;114:1482–9.CrossRefPubMed
19.
go back to reference Fox BD, Kassirer M, Weiss I, Raviv Y, Peled N, Shitrit D, et al. Ambulatory rehabilitation improves exercise capacity in patients with pulmonary hypertension. J Card Fail. 2011;17:196–200.CrossRefPubMed Fox BD, Kassirer M, Weiss I, Raviv Y, Peled N, Shitrit D, et al. Ambulatory rehabilitation improves exercise capacity in patients with pulmonary hypertension. J Card Fail. 2011;17:196–200.CrossRefPubMed
20.
go back to reference Ley S, Fink C, Risse F, Ehlken N, Fischer C, Ley Zaporozhan J, et al. Magnetic resonance imaging to assess the effect of exercise training on pulmonary perfusion and blood flow in patients with pulmonary hypertension. Eur Radiol. 2013;23:324–31.CrossRefPubMed Ley S, Fink C, Risse F, Ehlken N, Fischer C, Ley Zaporozhan J, et al. Magnetic resonance imaging to assess the effect of exercise training on pulmonary perfusion and blood flow in patients with pulmonary hypertension. Eur Radiol. 2013;23:324–31.CrossRefPubMed
21.
go back to reference ATS statement. Guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111–7.CrossRef ATS statement. Guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111–7.CrossRef
22.
go back to reference Lacasse Y, Brosseau L, Milne S, Martin S, Wong E, Guyatt GH, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2002;3:CD003793.PubMed Lacasse Y, Brosseau L, Milne S, Martin S, Wong E, Guyatt GH, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2002;3:CD003793.PubMed
23.
go back to reference Peytremann-Bridevaux I, Staeger P, Bridevaux PO, Ghali WA, Burnand B. Effectiveness of chronic obstructive pulmonary disease-management programs: systematic review and meta-analysis. Am J Med. 2008;121:433–43.CrossRefPubMed Peytremann-Bridevaux I, Staeger P, Bridevaux PO, Ghali WA, Burnand B. Effectiveness of chronic obstructive pulmonary disease-management programs: systematic review and meta-analysis. Am J Med. 2008;121:433–43.CrossRefPubMed
24.
go back to reference Van der Meer S, Zwerink M, van Brussel M, van der Valk P, Wajon E, van der Palen J. Effect of outpatient exercise training programmes in patients with chronic heart failure: a systematic review. Eur J Prev Cardiol. 2012;19(4):795–803.CrossRefPubMed Van der Meer S, Zwerink M, van Brussel M, van der Valk P, Wajon E, van der Palen J. Effect of outpatient exercise training programmes in patients with chronic heart failure: a systematic review. Eur J Prev Cardiol. 2012;19(4):795–803.CrossRefPubMed
25.
go back to reference Rasekaba T, Lee AL, Naughton MT, Williams TJ, Holland AE. The six-minute walk test: a useful metric for the cardiopulmonary patient. Intern Med J. 2009;39:495–501.CrossRefPubMed Rasekaba T, Lee AL, Naughton MT, Williams TJ, Holland AE. The six-minute walk test: a useful metric for the cardiopulmonary patient. Intern Med J. 2009;39:495–501.CrossRefPubMed
26.
go back to reference Savarese G, Paolillo S, Costanzo P,D, Amore C, Cecere M, Losco T, et al. Do changes of 6-minute walk distance predict clinical events in patients with pulmonary arterial hypertension? A meta-analysis of 22 randomized trials. J Am Coll Cardiol. 2012;60:1192–201.CrossRefPubMed Savarese G, Paolillo S, Costanzo P,D, Amore C, Cecere M, Losco T, et al. Do changes of 6-minute walk distance predict clinical events in patients with pulmonary arterial hypertension? A meta-analysis of 22 randomized trials. J Am Coll Cardiol. 2012;60:1192–201.CrossRefPubMed
27.
go back to reference Macchia A, Marchioli R, Marfisi R, Scarano M, Levantesi G, Tavazzi L, et al. A meta-analysis of trials of pulmonary hypertension: a clinical condition looking for drugs and research methodology. Am Heart J. 2007;153:1037–47.CrossRefPubMed Macchia A, Marchioli R, Marfisi R, Scarano M, Levantesi G, Tavazzi L, et al. A meta-analysis of trials of pulmonary hypertension: a clinical condition looking for drugs and research methodology. Am Heart J. 2007;153:1037–47.CrossRefPubMed
28.
go back to reference Golpe R, Castro-Anon O, Perez-de-Llano LA, Gonzalez Juanatey C, Muniz Fernandez C, Testa Fernandez A, et al. Prognostic significance of six-minute walk test in non-group 1 pulmonary hypertension. Heart Lung. 2014;43:72–6.CrossRefPubMed Golpe R, Castro-Anon O, Perez-de-Llano LA, Gonzalez Juanatey C, Muniz Fernandez C, Testa Fernandez A, et al. Prognostic significance of six-minute walk test in non-group 1 pulmonary hypertension. Heart Lung. 2014;43:72–6.CrossRefPubMed
29.
go back to reference Hansen JE, Sun XG, Yasunobu Y, Garafano RP, Gates G, Barst RJ, et al. Reproducibility of cardiopulmonary exercise measurements in patients with pulmonary arterial hypertension. Chest. 2004;126:816–24.CrossRefPubMed Hansen JE, Sun XG, Yasunobu Y, Garafano RP, Gates G, Barst RJ, et al. Reproducibility of cardiopulmonary exercise measurements in patients with pulmonary arterial hypertension. Chest. 2004;126:816–24.CrossRefPubMed
30.
go back to reference Paolillo S, Farina S, Bussotti M, Iorio A, PerroneFilardi P, Piepolil MF, et al. Exercise testing in the clinical management of patients affected by pulmonary arterial hypertension. Eur J Prev Cardiol. 2012;19:960–71.CrossRefPubMed Paolillo S, Farina S, Bussotti M, Iorio A, PerroneFilardi P, Piepolil MF, et al. Exercise testing in the clinical management of patients affected by pulmonary arterial hypertension. Eur J Prev Cardiol. 2012;19:960–71.CrossRefPubMed
31.
go back to reference Zafrir B. Exercise training and rehabilitation in pulmonary arterial hypertension: rationale and current data evaluation. J Cardiopulm Rehabil Prev. 2013;33:263–73.CrossRefPubMed Zafrir B. Exercise training and rehabilitation in pulmonary arterial hypertension: rationale and current data evaluation. J Cardiopulm Rehabil Prev. 2013;33:263–73.CrossRefPubMed
32.
go back to reference Groepenhoff H, Vonk-Noordegraaf A, van de Veerdonk MC, Boonstra A, Westerhof N, Bogaard HJ. Prognostic relevance of changes in exercise test variables in pulmonary arterial hypertension. PLoS One. 2013;8:e72013.CrossRefPubMedPubMedCentral Groepenhoff H, Vonk-Noordegraaf A, van de Veerdonk MC, Boonstra A, Westerhof N, Bogaard HJ. Prognostic relevance of changes in exercise test variables in pulmonary arterial hypertension. PLoS One. 2013;8:e72013.CrossRefPubMedPubMedCentral
33.
go back to reference Chua R, Keogh AM, Byth K, O’Loughlin A. Comparison and validation of three measures of quality of life in patients with pulmonary hypertension. Intern Med J. 2006;36:705–10.CrossRefPubMed Chua R, Keogh AM, Byth K, O’Loughlin A. Comparison and validation of three measures of quality of life in patients with pulmonary hypertension. Intern Med J. 2006;36:705–10.CrossRefPubMed
34.
go back to reference Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration. BMJ. 2009;339:b2700.CrossRefPubMedPubMedCentral Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration. BMJ. 2009;339:b2700.CrossRefPubMedPubMedCentral
35.
go back to reference Fagard RH, Staessen JA, Thijs L. Advantages and disadvantages of the meta-analysis approach. J Hypertens Suppl. 1996;14:S9–12.CrossRefPubMed Fagard RH, Staessen JA, Thijs L. Advantages and disadvantages of the meta-analysis approach. J Hypertens Suppl. 1996;14:S9–12.CrossRefPubMed
Metadata
Title
Exercise training improves physical fitness in patients with pulmonary arterial hypertension: a systematic review and meta-analysis of controlled trials
Authors
Roselien Buys
Andrea Avila
Véronique A Cornelissen
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2015
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/s12890-015-0031-1

Other articles of this Issue 1/2015

BMC Pulmonary Medicine 1/2015 Go to the issue